Xiong Shengchun, Tang Keiyui, Luo Feifei
Division of Thoracic, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China.
Department of Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China.
Ann Med Surg (Lond). 2022 Aug 19;81:104448. doi: 10.1016/j.amsu.2022.104448. eCollection 2022 Sep.
We report a rare case of a patient with a mass involving both the hilum and the heart, but its specific nature could not be determined. SCLC was confirmed by postoperative pathology. It revealed that radical surgical resection for T4 SCLC should be considered an important part of multimodality treatment.
A 49-year-old gentleman complained of mild chest tightness for a week. Two large mass lesions were detected on CECT in the left atrium and left hilum. After an MDT discussion, an extended resection was recommended. Postoperative pathology denoted a complete excision with no residuals and negative lymph nodes.
Due to the rarity of lung metastases to the heart, it is vital to determine the homology between the hilar mass and the cardiac mass. Based on this, simultaneous surgical treatment is done and it is very beneficial for patients by eliminating those hazards, such as acute mechanical cardiac obstruction, and cardiac embolism. Our literature review demonstrates that the SCLC tumour progresses rapidly after cardiac metastasis, limiting the chance of a complete resection. Furthermore, complete resection of T4 tumours in NSCLC has been attempted many times, so it should also be tried on SCLC.
It is common for SCLC tumours to progress rapidly once they havemetastasized to the heart. An aggressive operation such as radical resection can reduce tumor burdens, minimize the risk of sudden acute death and improve patient follow-up treatment, all of which may prolong the survival of patients.
我们报告一例罕见病例，患者的肿块累及肺门和心脏，但无法确定其具体性质。术后病理证实为小细胞肺癌（SCLC）。结果表明，对于T4期SCLC，根治性手术切除应被视为多模式治疗的重要组成部分。
一名49岁男性主诉轻度胸闷一周。胸部增强CT（CECT）检查发现左心房和左肺门有两个大的肿块病变。经过多学科团队（MDT）讨论，建议进行扩大切除。术后病理显示切除完整，无残留，淋巴结阴性。
由于肺癌转移至心脏较为罕见，确定肺门肿块与心脏肿块的同源性至关重要。基于此，进行了同步手术治疗，这对消除急性机械性心脏梗阻和心脏栓塞等危险因素非常有益。我们的文献综述表明，SCLC肿瘤发生心脏转移后进展迅速，限制了完整切除的机会。此外，非小细胞肺癌（NSCLC）中T4肿瘤的完整切除已多次尝试，因此SCLC也应尝试。
SCLC肿瘤一旦转移至心脏通常进展迅速。根治性切除等积极的手术可以减轻肿瘤负荷，降低猝死风险，改善患者后续治疗，所有这些都可能延长患者的生存期。
